Medical groups, hospitals, and healthcare organizations are facing an uncertain healthcare environment, escalating costs, and declining reimbursements. These organizations continue to seek strategies and solutions to decrease costs, increase revenue, and accelerate their provider enrollment process in order to obtain more timely reimbursement.
It is against this backdrop that VerityStream examined the current and changing landscape of provider enrollment and the implications for medical groups, hospitals and healthcare organizations. We present our research collected in early 2017 from 505 credentialing and provider enrollment professionals throughout the U.S. who indicate that creating efficiency and automation are higher priorities in their organization than in recent years. Here are some general conclusions we draw from the survey results:
Current Methods Are Not Satisfactory
Organizations are seeking alternative methods within their region and state to form healthcare collaborative relationships with payers as a method to secure revenue-saving opportunities for the collaborative healthcare organization members. These arrangements typically include delegated credentialing agreements.
Healthcare organizations look to develop payer enrollment processes which generate dashboard outcome data to report the time it takes to onboard providers with commercial payers, Medicaid, and Medicare. The outcome metrics are methods to monitor efficiencies, which include revenue dollars on hold attributed to payer enrollment. Imagine the value of shaving off 7 to 15 days from the time it takes to enroll a provider.
Paper and Spreadsheets Are Not Working with Adequate Speed
Leaders are looking to optimize software solutions which provide methods to improve efficient communication and required payer ongoing verifications, as well as integration with the Council for Accountable Quality Healthcare (CAQH), State Medicaid, and Medicare enrollment.
Attention to the Bottom Line
There is no denying the heightened awareness of provider enrollment’s impact on a healthcare organization’s financial bottom line. Over 50% of those who participated in the survey have been working in their current role for over fifteen years. These individuals are—in many organizations—taking the lead to improve processes. The survey results from the over 500 credentialing and provider enrollment professionals provides crucial data to confirm the need for substantial change. The challenge for today’s credentialing and provider enrollment professionals is to identify best practices in payer enrollment and incorporate those best practices, industry requirements, and Medicare and Medicaid regulations using available technology and marshalling stakeholders within the organization that have vital data to contribute to an accurate data set. The call to action is compelling—the financial health of our healthcare organizations depends upon a well-orchestrated and coordinated approach and leadership from the executive suite.
VerityStream delivers enterprise-class solutions that are transforming credentialing, enrollment, privileging, and evaluation for healthcare organizations across the United States. We currently serve over 2,500 hospitals and 1,300 outpatient care settings in the U.S. including ambulatory surgery centers, urgent cares, and medical groups. VerityStream and our solutions resulted from the merging of Sy.Med, HealthLine Systems, Morrisey, and CredentialMyDoc representing over 75 years of industry experience. HealthStream, (NASDAQ: HSTM), based in Nashville, TN, is our parent company, supporting us through innovation, investment, and the development of market-leading products. VerityStream has over 225 employees spanning headquarters in Boulder, CO and satellite offices in San Diego, CA; Nashville, TN; Chicago, IL; and Savannah, GA.
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